With the Newfoundland and Labrador government and the province's medical association at odds over how to address a shortage of family doctors, those struggling without a doctor say it's getting harder by the day.
"This is the worst I've ever seen it," says Dave Kane, 75, of Stephenville Crossing.
The Newfoundland and Labrador Medical Association has accused the provincial government of having no plan to deal with doctor shortages, while Health Minister John Haggie long-term work is ongoing to address the issue.
On Thursday, the association called off negotiations with the province on a new contract for the more than 1,300 practising physicians it represents, leaving people like Dave Kane looking for answers.
Kane said the recent departures of two physicians in the Stephenville area leaves even fewer options for an area already struggling with a family doctor shortage, and while a new family doctor has opened a clinic in Stephenville Crossing, many have been unsuccessful in having their files transferred there.
Kane himself will be without a doctor by the end of the month.
He said residents do have access to a nurse practitioner who can fill some of the duties of a physician, such as writing prescriptions. But since MCP doesn't allow nurse practitioners to bill for services rendered, patients pay $30 out-of-pocket to see one, Kane said.
To avoid that cost, many go to the emergency room to get their prescriptions filled.
"Every other day, the emergency is full," he said. "Now there's going to be added stress on the emergency department."
Kane, who is a member of the West Coast Health Care Action Committee, said meetings often focus on one question for which few seem to have an answer.
"We had a lot of good doctors here, and they left," he said. "They don't really come out and tell you why they're leaving. How come we're losing doctors that come here?"
'It puts a strain on the family'
In Bay D'Espoir on Newfoundland's south coast, Tammy Davis's parents are among the roughly 98,000 people in the province without a family doctor, according to the NLMA.
Davis's father, Conrad, 80, suffered a brain tumour in 2010 and a subsequent postoperative bleed. While specialized services like occupational therapy weren't available, the family had no problem finding a primary caregiver in Bay D'Espoir when they moved there.
"Now, not having the access to that, when my father requires medical attention, it puts a strain on the family," Davis said. "And especially my mother as caregiver."
Primary care service has been intermittent in the community, Davis said, and the current locum doctor leaves in two weeks.
After that, "anybody who requires any help from a doctor has to be taken by ambulance or take themselves to another centre," Davis said.
Ambulances will go to Harbour Breton for triage, she said, and in many cases patients will be sent to a larger centre from there.
Davis' father is prone to seizures, she said — between four and six per year, on average.
She said her mother, who doesn't drive, is "in constant fight and flight mode." Often, she'll assess whether a seizure can be handled at home, or whether it will warrant a day-and-a-half in the back of an ambulance.
"Sometimes there's multiple trips that have to be made," Davis said. "Harbour Breton, Grand Falls, back to Harbour Breton, back to St. Alban's. Sometimes you have to make your own way home."
Davis said the situation causes her significant stress. She said her family's home is in Bay D'Espoir, and the focus should be on providing better health care to people in their communities.
"We've got to figure out why we spend so much and get so poor outcomes," she said. "Until we understand why that is, throwing money at things is not the answer."